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<body>
<form id="form2" name="form2" method="post" action="">
  <p class="zt9">请输入派车单号
    <label>
      <input type="text" name="textfield9" id="textfield9" />
    </label>
    <label>
      <input type="submit" name="button3" id="button3" value="提交" />
    </label>
  </p>
</form>
<form id="form1" name="form1" method="post" action="">
  <table border="0"   cellpadding="1"   cellspacing="1"   bgcolor="#CEDFF7">
    <tr>
      <td colspan="5" align="center" bgcolor="#CEDFF7" class="zt10">修改确认单</td>
    </tr>
    <tr class="zt9">
      <td width="104" bgcolor="#FFFFFF">派车单号</td>
      <td colspan="2" bgcolor="#FFFFFF">NO.</td>
      <td width="152" bgcolor="#FFFFFF">时间：</td>
      <td width="199" bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td rowspan="4" bgcolor="#FFFFFF"><span class="zt9">车辆基本信息</span></td>
      <td width="114" bgcolor="#FFFFFF"><span class="zt9">车号：</span></td>
      <td width="225" bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">司机：</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">板号：</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">电话</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">车型</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">绩效工资</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">箱型</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td rowspan="3" bgcolor="#FFFFFF"><span class="zt9">提货客户信息</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">客户</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">联系人</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">装货地</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">电话</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">要求提货时间</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">要求送达时间</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td rowspan="5" bgcolor="#FFFFFF"><span class="zt9">货物信息</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">货物名称</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">货物类别</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">件数：</span></td>
      <td bgcolor="#FFFFFF"><label>
        <input type="text" name="textfield" id="textfield" />
      </label></td>
      <td bgcolor="#FFFFFF"><span class="zt9">吨位 ：</span></td>
      <td bgcolor="#FFFFFF"><input type="text" name="textfield3" id="textfield3" /></td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">体积</span></td>
      <td bgcolor="#FFFFFF"><input type="text" name="textfield2" id="textfield2" /></td>
      <td bgcolor="#FFFFFF"><span class="zt9">包装类型</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">装卸类别</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">装卸时间</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">行驶类型</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
    </tr>
    <tr>
      <td rowspan="2" bgcolor="#FFFFFF"><span class="zt9">卸货客户信息</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">卸货客户名称</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">联系人</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">卸货地</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">电话</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td rowspan="4" bgcolor="#FFFFFF"><span class="zt9">行车及收货信息</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">收货情况：</span></td>
      <td bgcolor="#FFFFFF"><label>
        <select name="select" id="select">
          <option>完好</option>
          <option>破损</option>
          <option>雨淋</option>
        </select>
      </label></td>
      <td bgcolor="#FFFFFF"><span class="zt9">车辆运行路线</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">运输里程：</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">高速限制 ： </span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">特殊情况的处理</span></td>
      <td bgcolor="#FFFFFF"><select name="select2" id="select2">
        <option>无</option>
        <option>大雨</option>
        <option>大雪</option>
        <option>交通事故</option>
      </select></td>
      <td bgcolor="#FFFFFF"><span class="zt9">车辆现运行情况</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">到车情况</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">实际到达时间</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td rowspan="10" bgcolor="#FFFFFF"><span class="zt9">收入费用信息</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">收入：</span></td>
      <td bgcolor="#FFFFFF"><input type="text" name="textfield4" id="textfield4" /></td>
      <td bgcolor="#FFFFFF"><span class="zt9">是否为现金收入</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">运输里程：</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">标准油耗：</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">预支费用：</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">高速限制 ： </span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">路桥费</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">燃油费</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">加油升数</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">货损货差件数</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">货损货差</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">罚款</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">其他费用</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
      <td bgcolor="#FFFFFF"><span class="zt9">回单日期</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">核销差额</span></td>
      <td colspan="3" bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">预支运费：</span></td>
      <td bgcolor="#FFFFFF"><input type="text" name="textfield5" id="textfield5" /></td>
      <td bgcolor="#FFFFFF"><span class="zt9">预支地点：</span></td>
      <td bgcolor="#FFFFFF"><input type="text" name="textfield7" id="textfield7" /></td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">到付运费：</span></td>
      <td bgcolor="#FFFFFF"><input type="text" name="textfield6" id="textfield6" /></td>
      <td bgcolor="#FFFFFF"><span class="zt9">到付地点：</span></td>
      <td bgcolor="#FFFFFF"><input type="text" name="textfield8" id="textfield8" /></td>
    </tr>
    <tr>
      <td rowspan="3" bgcolor="#FFFFFF"><span class="zt9">备注</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
      <td bgcolor="#FFFFFF">&nbsp;</td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
    </tr>
    <tr>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
      <td bgcolor="#FFFFFF"><span class="zt9">　</span></td>
    </tr>
  </table>
  <p>
    <label>
      　　　　　　　　　　　　　　　　　　　　
        <input type="submit" name="button" id="button" value="提交" />
    </label>
    <input type="submit" name="button2" id="button2" value="提交" />
  </p>
</form>
<p>&nbsp;</p>
</body>
</html>